BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 747|
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VETO
Bill No: SB 747
Author: Kehoe (D)
Amended: 8/26/11
Vote: 21
SENATE BUSINESS, PROF & ECON DEVELOP COMM : 6-2, 4/11/11
AYES: Price, Corbett, Correa, Hernandez, Negrete McLeod,
Vargas
NOES: Walters, Wyland
NO VOTE RECORDED: Emmerson
SENATE APPROPRIATIONS COMMITTEE : 6-3, 5/9/11
AYES: Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
NOES: Walters, Emmerson, Runner
SENATE FLOOR : 25-12, 5/16/11
AYES: Alquist, Calderon, Corbett, Correa, De Le�n,
DeSaulnier, Evans, Hancock, Hernandez, Kehoe, Leno, Lieu,
Liu, Lowenthal, Negrete McLeod, Padilla, Pavley, Price,
Rubio, Simitian, Steinberg, Vargas, Wolk, Wright, Yee
NOES: Anderson, Berryhill, Blakeslee, Cannella, Dutton,
Emmerson, Fuller, Gaines, Harman, Huff, La Malfa, Runner
NO VOTE RECORDED: Strickland, Walters, Wyland
ASSEMBLY FLOOR : 47-26, 9/1/11 - See last page for vote
SENATE FLOOR : 24-14, 9/2/11
AYES: Calderon, Corbett, Correa, De Le�n, DeSaulnier,
Evans, Hancock, Hernandez, Kehoe, Leno, Lieu, Liu,
Lowenthal, Negrete McLeod, Padilla, Pavley, Price, Rubio,
Simitian, Steinberg, Vargas, Wolk, Wright, Yee
NOES: Anderson, Berryhill, Blakeslee, Cannella, Dutton,
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Emmerson, Fuller, Gaines, Harman, Huff, La Malfa, Runner,
Strickland, Wyland
NO VOTE RECORDED: Alquist, Walters
SUBJECT : Continuing education: lesbian, gay, bisexual,
and
transgender patients
SOURCE : Equality California
DIGEST : This bill requires physicians and surgeons,
registered nurses, licensed vocational nurses,
psychologists, psychiatric technicians, marriage and family
therapists, and clinical social workers, to take at least
one continuing education course that provides instruction
on cultural competency, sensitivity, and best practices for
providing adequate care to lesbian, gay, bisexual, and
transgender persons (LGBT) on and after January 1, 2013, as
specified.
Assembly Amendments : 1) require persons licensed by the
Board of Register Nursing (BRN) to complete the required
training by January 1, 2018 rather than January 1, 2017; 2)
provide that the BRN shall not enforce this continuing
education requirement as it does other continuing education
requirements and shall instead require licensees disclose
on their renewal form or a supplemental form whether they
have complied with the requirements of this bill; 3)
provide that the Medical Board of California may exempt
physicians and surgeons by practice status category from
the requirements of this bill if the physician and surgeons
does not engage in direct patient care, does not provide
patient consultations, or does not reside in the State of
California; 4) and specifically exempts physicians and
surgeons practicing in pathology or radiology specialty
areas from the requirements of the bill.
ANALYSIS : Existing law:
1.Establishes the Medical Board of California (MBC) to
regulate physicians and surgeons. Establishes continuing
education (CE) standards for physicians and surgeons.
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Requires that on and after July 1, 2006, all continuing
medical education courses shall contain curriculum that
includes cultural and linguistic competency in the
practice of medicine.
2.Requires the MBC to adopt standards for the certification
of medical assistants.
3.Establishes the Board of Registered Nursing to regulate
the practice of registered nurses. Requires that any
registered nurse that renews a license to submit proof of
CE courses in the registered nurse field, as specified.
4.Establishes the Board of Vocational Nurses and
Psychiatric Technicians to regulate the practice of
licensed vocational nurses and psychiatric technicians.
Requires licensed vocational nurses and psychiatric
technicians to complete CE courses as part of licensure
renewal.
5.Establishes the Physician Assistant Committee within the
MBC to regulate the practice of physician assistants.
Prescribes CE requirements for physician assistants.
6.Establishes the Board of Psychology to regulate the
practice of psychologists. Requires licensed
psychologists to complete CE courses.
7.Establishes the Board of Behavioral Sciences to regulate
the practice of marriage and family therapists (MFTs) and
clinical social workers. Prescribes CE requirements for
these practitioners.
8.Establishes the Department of Public Health (DPH), to
among other functions, provide certification for nurse
assistants. Specifies the requirements for an approved
nurse assistant training program.
This bill:
1.Requires, on and after January 1, 2013, the healing arts
boards or committees, except BRN, that regulate the
professions specified above to require their licensees to
take at least one CE course that provides instruction on
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cultural competency, sensitivity, and best practices for
providing adequate care to LGBT persons. The course must
be between two and five hours in duration and must
contain content similar to the content described in the
publication of the Gay and Lesbian Medical Association
entitled "Guidelines for Care of Lesbian, Gay, Bisexual,
and Transgender Patients." The boards or committees may
specify the required contents of the course by
regulation.
2.Requires persons licensed by these boards, except the
BRN, before January 1, 2013, to complete the course no
later than January 1, 2017. Persons who are newly
licensed by these boards on and after January 1, 2013,
must complete the course within four years of their
initial license issuance date or their second license
renewal date, whichever occurs first. These boards must
enforce this requirement in the same manner as they
enforce other required CE requirements.
3.Allows the Medical Board of California to exempt
physicians and surgeons by practice status category from
the requirements of this bill if the physician and
surgeon does not engage in direct patient care, does not
provide patient consultations, or does not reside in
California.
4.Exempts from this bill's requirements physicians and
surgeons practicing in pathology or radiology specialty
areas.
5.Requires persons licensed by BRN before January 1, 2013,
to complete the course no later than January 1, 2018.
The BRN must not enforce this requirement nor shall the
BRN ensure compliance of licensees except to inform
licensees that this requirement exists and that proof of
compliance must be submitted during the license renewal
process. The requirement applies to all persons licensed
by the BRN, including nurse practitioners.
6.Requires, on and after January 1, 2013, at least two, but
not more than five, hours of the classroom training
required for nurse assistant certification to provide
instruction on cultural competency, sensitivity, and best
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practices for providing adequate care to LGBT persons.
Nurse assistants certified by the Department of Public
Health (DPH) before January 1, 2013, must complete the
course no later than January 1, 2017. Persons who are
newly certified on and after January 1, 2013, must
complete the course within four years of their initial
certificate issuance date or their second certificate
renewal date, whichever occurs first. The instruction
must contain content similar to the content described in
the publication of the Gay and Lesbian Medical
Association, as specified. DPH may specify the required
contents of the course by regulation, and must enforce
this requirement in the same manner as it enforces other
training requirements.
Background
Physicians and surgeons, physician assistants, registered
nurses, licensed vocational nurses, psychologists,
psychiatric technicians, MFTs and clinical social workers
must complete continuing education courses to renew their
license. Healing arts boards generally do not mandate the
courses that must be taken but they must be relevant to the
licensee's area of practice. However, there are certain
courses that are required to be taken by specific
licensees. For example, physicians and surgeons are
required to complete CE courses in cultural and linguistic
competency, pain management and the treatment of terminally
ill and dying patients. Additionally, psychologists are
required to show evidence of completion of training in
human sexuality, child abuse assessment and training, and
aging and long-term care. These required continuing
education courses, similar to the requirements of this
bill, are one-time course requirements.
Comments
Currently, DPH's Licensing and Certification Section is
responsible for the certification of nurse assistants. DPH
prepares and maintains a list of approved training programs
for nurse assistants, including programs conducted by
skilled nursing or intermediate care facilities.
Currently, a nurse assistant training program includes a
16-hour orientation program for facilities participating in
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the Medicare or Medicaid programs; at least 60 classroom
hours of training on basic nursing skills, patient safety
and rights, as specified; 100 hours of supervised and
on-the-job training clinical practice. This bill requires
that for purposes of certification, nurse assistants, on
and after January 1, 2013, must fulfill at least two, but
not more than five hours of classroom training on cultural
competency, sensitivity, and best practices for providing
adequate care to LGBT persons.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Major Provisions 2011-12 2012-13
2013-14 Fund
Continuing education
requirement
- BRN* $35 $71 $71 Special**
- BVNPT*** $35 $61 $61
Special****
- Other Minor,
absorbable costs, ongoing
Special*****
* Board of Registered Nursing
** Board of Registered Nursing Fund
*** Board of Vocational Nursing and Psychiatric Technicians
**** Vocational Nursing and Psychiatric Technicians Fund
*****Psychology Fund, Contingent Fund of the Medical Board
of California, Behavioral Science Examiners' Fund
SUPPORT : (Verified 9/1/11)
Equality California (source)
Los Angeles Mayor Antonio Villaraigosa
American Nurses Association of California
Asian & Pacific Islander American Health Forum
Antioch University, Los Angeles
California Association of Marriage and Family Therapists,
San Francisco Chapter
California Communities United Institute
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California Mental Health Directors Assn.
California National Organization for Women
California STD Controllers Association
Dr. Susan Love Research Foundation
Gay and Lesbian Medical Association
Greater San Diego Business Association
Lavender Seniors of the East Bay
LGBT Psychotherapists Association of the San Francisco Bay
Area
Lesbian and Gay Psychotherapy Association of Southern
California
Mental Health America of Northern California
National Association of Social Workers
Openhouse
Pacific Center for Human Growth
Planned Parenthood Affiliates of California
Planned Parenthood of Mar Monte and Orange and San
Bernardino Counties
The Trevor Project
OPPOSITION : (Verified 9/1/11)
Board of Registered Nursing
California Academy of Family Physicians
California Association of Marriage and Family Therapists
California Orthopaedic Association
California Psychological Association
Department of Consumer Affairs
Department of Finance
Kaiser Permanente
ARGUMENTS IN SUPPORT : Supporters, such as the Gay and
Lesbian Medical Association state that continuing education
addressing cultural competency in LGBT health is a critical
component to improving health outcomes for California's
LGBT persons. Additionally, the California STD Controllers
Association, comprised of STD control officers who lead
sexually transmitted disease prevention and control
programs in California, state that education can improve a
providers' ability to care for LGBT patients, improve
knowledge and attitudes toward LGBT health, and reduce
health disparities among LGBT residents, including those
related to sexual health.
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ARGUMENTS IN OPPOSITION : The California Psychological
Association has taken an oppose position and states that
competency to provide care to LGBT individuals is currently
being taught in multicultural courses, family systems,
lifespan development, and in real life applications through
practicum and internship. Further, it points out that the
course in human sexuality currently includes the study of
physiological-psychological and social-cultural variable
associated with sexual identity, sexual behavior, or sexual
disorders.
GOVERNOR'S VETO MESSAGE:
"I am returning Senate Bill 747 without my signature.
This bill would order doctors, nurses and other
licensed health care professionals to take a brief
"continuing education" course on how to treat and care
for lesbian, gay, bisexual, and transgender persons.
I believe that respective licensing boards are better
suited than the Legislature or the Governor to decide
these matters."
ASSEMBLY FLOOR : 47-26, 9/1/11
AYES: Alejo, Allen, Ammiano, Atkins, Beall, Block,
Blumenfield, Bradford, Brownley, Buchanan, Butler,
Charles Calderon, Campos, Carter, Cedillo, Chesbro,
Dickinson, Eng, Feuer, Fong, Fuentes, Furutani, Galgiani,
Gatto, Gordon, Hall, Hayashi, Hill, Huber, Hueso,
Huffman, Lara, Bonnie Lowenthal, Ma, Mendoza, Mitchell,
Monning, Perea, V. Manuel P�rez, Portantino, Skinner,
Solorio, Swanson, Torres, Wieckowski, Yamada, John A.
P�rez
NOES: Achadjian, Bill Berryhill, Conway, Cook, Donnelly,
Fletcher, Beth Gaines, Garrick, Grove, Halderman, Harkey,
Jeffries, Jones, Knight, Logue, Mansoor, Miller, Morrell,
Nestande, Nielsen, Norby, Olsen, Silva, Smyth, Valadao,
Wagner
NO VOTE RECORDED: Bonilla, Davis, Gorell, Hagman, Roger
Hern�ndez, Pan, Williams
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JJA:nl 1/4/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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